Adjustable tension splint



March 2, 1943. 2,312,523

M S. CORBETT ADJUSTABLE TENSION SPLINT Filed July 15, 1942 3 Sheets-Sheet l kgy/cll fb @M March 2, 1943. M. s, CORBETT 2,312,523

I ADJUSTABLE TENSION SPLINT Filed July 15} 1942 's Sheets-Sheet 2 729 I {834%IAW r79 M. S. CORBETT ADJUSTABLE TENSION SPLINT March 2, 1943.

Filed July 1:5, 1942 3 Sheets-Sheet 3 Patented Mar. 2, 1943 UNITED STATES ?TNT UFFICE ADJUSTABLE TENSION SPLINT Mitchell S. Corbett, Oak Park, Ill.

Application July 13, 1942, Serial No. 450,653

9 Claims.

The present invention relates generally to traction splints, and particularly to traction splints for the treatment of fractures of the proximal phalanges of the thumb and fingers and the middle phalanges of the fingers.

The proximal and middle phalanges of the digits of the hand are often injured in industrial and other accidents, and because of the anatomical peculiarities of the members involved, satisfactory treatment of these fractures is very difficult. Especially is it difficult to obtain proper immobilization of the members while maintaining adequate traction along the longitudinal axis of the digit to obviate permanent loss or impairment of function.

Various splints have been devised for use in the treatment of digital fractures. None, however, has proven entirely satisfactory, particularly for the treatment of fractures of the proximal and middle digital phalanges, and the principal object of the present invention is to provide an improved traction splint for the treatment of fractures of this type. It is also an object of the invention to provide an improved traction splint for the treatment of fractures of the stated type which shall not only produce better results, with less discomfort to the patient, than the splints heretofore known to the art, but which, in addition, shall be of simple construction and inexpensive to manufacture in order that the splint may be made available to hospitals, first aid stations, and practitioners generally.

These and other objects and the various advantages of the invention will be made more apparent by reference to the accompanying drawings'and the following description of certain preferred embodiments thereof. In the drawings: Fig. l is a top plan view of a traction splint, in accordance with the present invention, designed for treating fractures of the proximal phalange of the thumb of the right hand;

Fig. 2 is a bottom plan view of the splint of 'ing the thumb splint of Figs. 1, 2, and 3 in use;

Fig. 6 is a top plan view of a traction finger splint constructed in accordance with the present invention;

Fig. '7 is a fragmentary side elevational view forearm engaging portion 15.

of the finger splint of Fig. 6 in use in the treatment of a fracture of the proximal phalange of the index finger of the right hand;

Fig. 8 is a fragmentary sectional view showing the details of a swivel connection forming a part of the splints illustrated in Figs. 6 and '7;

Fig. 9 is a fragmentary perspective view, partially in section, showing the details of the spool locking means forming a part of the splints illustrated in Figs. 6 and 7;

Figs. 10 and 11 are respectively plan and side elevational views of a cock-up hand support which may be used in connection with the splints of the present invention;

Fig. 12 is a top plan View, similar to Figure 6, of another traction finger splint constructed in accordance with the present invention;

Fig. 13 is an enlarged sectional view on the line I3l3 of Fig. 12;

Fig. 14 is an enlarged end view of the spool unit constituting a part of the splint illustrated more completely in Fig. 12; and

Fig. 15 is a perspective view of a wrench for use in connection with the spool unit which is illustrated particularly in Figs. 12 and 13.

The thumb splint illustrated particularly in Figs. 1, 2, 3 and 5 includes a curved, forearm engaging portion [5 which is preferably made of heavy sheet metal, such as aluminum, or of plastic. Rigidly attached to the forearm engaging portion I5 of the splint is an adjustable hand support which includes an upwardly curved, longitudinally extending part IT and a transversely extending, hand engaging part l9 having upstanding ends 2| for aiding in holding the hand of the patient in position. The longitudinally extending part ll of the hand support is attached to the forearm engaging portion [5 of the splint by screw or other fastenings 23, and slots 24 are provided so that the position of the hand support may be adjusted longitudinally relative to the The transversely extending, hand engaging part I9 is adjustably supported on the longitudinal part H by means of a screw fastening 25.

Motion of the hand engaging part ll about the screw fastening 25 is limited in either direction by means of a pair of downwardly extending, punched out, projections 26 which engage suitable arcuate slots 21 formed in the adjacent, underlying portions of the longitudinally extending part ll, as illustrated.

The forearm engaging portion I5 should be quite stiff and may be conveniently supplied with straps 2'! whereby it is fastened in place. The

applied thereto.

which is attached to the arm engaging portion I of the splint and to the longitudinally extending support part I! for the hand support element by means of one of the screw fastenings'23 and an additional screw fastening 33, as illustrated.

Adjustment of the position of the spool and ratchet assembly relative to the other elements of the splint is made possible by the provision of slotted openings for cooperating with the screw fastenings 23 and 33.

The cylindrical spool 29 may be constructed of wood or other material. It is supported upon and keyed to a suitable stub shaft 31 (Fig. 3) which in turn is .supported for rotative movement upon the spool support arm 3|. The stub shaft 37 is provided at its lower end with a ratchet gear 39 which is adapted to engage and coact with a suitable spring pressed pawl 4| supported adjacent thereto. The spool supporting stub shaft 31 terminates at its lower end in a square portion 43 which is adapted to be engaged by a wrench or keyduring the use of the split. The axis of rotation of the spool 29 extends substantially at right angles to the arm engaging portion l5 of a the splint. For convenience in making fiuoroscope or other X-ray examinations during use of the splint, it is desirable that the various parts of the spool and ratchet assembly and the hand support shall be made of aluminum or other material which is transparent to X-rays.

The thumb splint illustrated in Figs. 1,2, 3, and 5 is particularly designed for use in the treating of fractures of the proximal phalange or second 7 joint of the thumb of the right hand; When the splint is to be used, a local anesthetic is administered to the patient so as to provide a digital nerve block. The distal phalange or first joint of the thumb is then cleaned and an antiseptic A stockinette bandage such as isillustrated at in Fig. 5 should then be placed on the forearm from the wrist to the elbow. Next, two strips 41 of adhesive tape about inch wide and several inches long are attached to the medial and lateral aspects (the two sides) of both the distal and the proximal phalanges, as illustrated particularly in Fig. 5. These strips 41 should extend Ibeyondthe interphalangal or second joint .of. the thumb and are reinforced and held in place by adhesive tape wrappings as illustrated at and 5|.

The free ends of the strips 41 of adhesive tape are .now affixed to the spool 29, the axis of which is horizontal, the splint being away from the patient with the spool end thereof nearest the patient and with the concavity of the forearm engaging portion {'5 extending toward the under surface .or dorsum of the forearm. The spool 29 is now rotated so that the ends of the adhesive tape strips 41 will be wound up thereon, this operation causing the splint to be drawn toward the patient, and when the unwound part of the strip A! is about one to one and a half inches .long,the splint is swung approximately 180 in a horizontal plane so as to bring the concave arm engaging portion [5 thereof against the under surface of the forearm. If found necessary, the

relative positions of the hand support and the spool and ratchet assembly can be adjusted longitudinally of the splint by loosening the screw fastenings 23 and 33 and sliding the member i5 and the supporting arm 3| in the slots 24 and 35. The crosswise position of the hand support may also be adjusted at this time. The thumb will be found to be naturally flexed over the spool substantially as shown in Fig. 5. In most instances it will be found desirable to insert a small piece 53 of wool felt or similar material, which may be beveled at the edges, between the lower surface or palmar aspect of the thumb and the spool.

I This piece of felt 53 acts as an elevator in raising the bone fragments into proper position. At the same time, it protects the adjacent tissue from excessive pressure resulting from the tensioning of the digit which follows.

The splint is now fastened on the forearm .of the patient by the straps 21 which are placed over the upper surface or dorsal aspect of the forearm, or the splint may be aflixed in place with a plain bandage. The spool 29 is then tightened against the ratchet 39 and pawl 4| so that traction is applied along the longitudinal axis of the fractured bone. The thumb should be X-rayed for position and immediate manual reduction made or additional traction applied if that be necessary. Adjustment of the position and size of the elevator 53 may also be made if necessary. The management of the fracture after application of the splint is simple, and usually consists of three to four weeks of immobilization. X-ray examinations are desirable during the healing period. 7

As previously stated, the splint illustrated in Figs. 1, 2, 3, and 5 is designed for treating fractures of the proximal phalange of the thumb of the right hand. The splint may be readily adapted for treatment of fractures of the proximal'phalanage of the thumb of the left hand by replacing the right hand spool and ratchet as sembly illustrated in Figs. 1, 2, 3, and 5 with a left hand unit such as is illustrated in Figure 4. To replace one unit with the other it is necessary merely to release one of the two screw fastenings 23 and the single screw fastening 33 and readjust 1 the cross arm part I9 of the hand support. a

The left hand spool and ratchet unit is structurally almost identical with the right hand unit. It includes a spool 29a which is supported upon and keyed to a stub shaft 31a. The stub shaftis journaled upon a support arm 3 la which is similar to the arm 3| except that it curves in the opposite direction. There is a ratchet 3911,.a

spring pressed pawl Ala, and a squared end portion 43a on the shaft similar to the corresponding parts of the right hand unit, and the support arm 35a is provided with slots 35a for engaging the screw fastenings 23 and 33. a

The mechanical principles which have been described in the foregoing are equally useful in connection with splints for the treatment of fractures of the proximal and middle phalanages of the fingers, and a splint embodying these principles and designed for this purpose is shown particularly in Figs. 6 and '7. This splint includes a curved arm engaging portion 55 preferably made from heavy sheet metal, and provided with straps 51 for fastening the splint to the arm of the patient. Because of the fact that this splint is designed for use on either hand, the hand rest is of the universal type. It may com prise a simple transversely extending cross piece 59, having upturned edges 6|, which is supported upon the arm engaging portion .of the splint by a suitable, rigid longitudinal support 63, as illus trated in Figs. 6, 7, and 8, or it may comprise a rest of the type described in connection with the thumb splint illustrated in Figs. 1, 2, 3, and 5. The longitudinal element 63 of the hand support is fastened to the arm engaging portion 55 of the splint by suitable screw fastenings 62 and is made adjustable relative to the arm engaging portion 55 through the provision of slots 64.

The fingers are supported and tension is applied thereto by means of a multiple spool support mechanism which includes a yoke 65 having a shaft 61 journaled thereon. The shaft 61 in turn supports four cylindrical spools 69. The spools 69 are rotatable upon the shafts 61, and mean is provided whereby one or more of the spools can be keyed thereto. In the particular structure illustrated in the drawings, this keying means includes, as is shown particularly in Fig. 9, a removable pin H which is adapted to extend through a suitable opening formed in each of the spool members to engage a slot 13 which is milled in the shaft 61 along the full length thereof. Suitable bearing supports are provided in the yoke for the ends of the shaft 61, and a ratchet wheel 15 is keyed to one end thereof. The ratchet wheel 15 coacts with a spring pressed pawl 11 supported on the yoke 65, as illustrated, and the shaft 61 terminates in a square end portion 19 to facilitate the turning thereof when the splint is in use.

In order to obtain traction along the proper axis of any finger of either hand which may be fractured, the finger support mechanism should be adjustable in at least laterally and preferably in both a lateral and a horizontal plane. This adjustment is provided in the splint shown in Figs. 6 and '7 by means of a swivel connection 8| intermediate the end portion 83 of the yoke 65 and the longitudinally extending support member 85 which serves to connect the end portion 83 of the yoke to the arm engaging portion of the splint.

The details of the swivel connection 8! are shown particularly in Fig. 8. As illustrated in that figure, the connection includes cooperating spherically shaped members 81 and 89, one of which is integral with the end portion 83 of the yoke and the other of which is integral with the forward end of the support member 85. The spherically shaped members 81 and 89 are movable relative to each other and are adapted to be held in position by means of a clamping bolt 9|, a concave pressure disc 93, and a nut 95 which may be integral with the member 89. A moderately large hole 91 in the member 81 makes possible sufficient relative movement between the spherical members 81 and 89 to accomplish necessary adjustment of the finger support mechanism. If desired, the engaging cylindrical surfaces of the two spherical members 8'! and 89 may be serrated or knurled as illustrated at 99 in order to obtain positive, rigid locking of the swivel parts in position.

Longitudinal adjustment of the finger support mechanism or spool unit relative to the arm engaging portion 55 is made possible by the provision of slotted openings I03 for the screw fastenings i! and 62.

The procedure of using the above described finger splint is substantially similar to the procedure followed in connection with the thumb splint, previously described. Anesthetic is administered locally or otherwise so as to provide a digital nerve block. The distal or first phalange of the finger is cleaned and a suitable antiseptic applied thereto. A stockinette bandage should be placed on the forearm from the wrist to the elbow as shown at I05. Two strips I07 of adhesive tape about one-half inch wide and several inches long are attached to the medial and lateral aspects (the two sides) of the finger as illustrated. The strips of tape I0! should extend beyond the second joint of the finger if a fracture of the proximal phalange is being treated and beyond the third joint if a fracture of the intermediate phalange is being treated.

. The tape strips I01 are fastened in place by suitable bindings or wrappings I99 which may also be of adhesive tape, and the extending ends of the tape are wrapped around the appropriate spool 69 of the multiple spool mechanism, that spool being keyed to the shaft 6'1 by one of the pins H. When this operation is being carried out, the splint will be pointed toward the patient with the spool mechanism foremost and the arm engaging portion 55 inverted from the position shown in Figs. 7 and 8. Once the ends of the tape I01 have been wrapped about the proper spool 69, the splint should be rotated in place so as to bring the concave arm engaging portion 55 thereof into contact with the volar or under surface of the arm of the patient. The finger will be found to be naturally flexed over the spool as shown, and if not, the necessary adjustment of the spool support means can be carried out by means of the swivel connection 8| provided for that purpose. The arm portion of the splint should then be fastened in place by tightening the straps 51, and it is desirable that the wrist be further restrained in position by means of a bandage such as illustrated at I II, this being especially useful when treating fractures of the middle phalange.

The spool 69 with the ends of the tape I01 thereon may be tightened against the ratchet 15 to apply the desired traction to the finger, and where required, an elevator which may comprise a piece of felt H3 similar to the piece of felt 53 used in connection with the thumb splint may be inserted between the spool and the surface of the finger. Checking and adjusting the position of the bone fragments by X-ray will, of course, be required.

I Some practitioners prefer to maintain the palm of the hand in an upwardly curved position during the treatment of fractures of the phalanges of .the thumb or fingers, and a hand support which is known in the profession as the cock-up type is commonly employed for this purpose. If desired, a cock-up type hand support may be used in connection with the splints of the present invention, and such a support is illustrated in Figs. 10 and 11. The device shown in those fingers includes a curved hand support portion 1 l 5 which may be of metal, and a suitable longitudinally extending support member II! which is provided with spaced, slotted openings H9 to permit the support being adjustably connected to the arm receiving portion of the splint in place of the hand supports previously described. The use of a cockup type hand support does not, of course, involve any difference in the treatment procedure.

It sometimes happens that more than one finger will be crushed in a single accident. In such instances it is necessary to treat two or more phalanges on the same hand at the same time. While this may be accomplished by the useof a splint of the type illustrated in Figs. 6 and 7, it is preferable to use a splint having means whereby the finger supporting spools can be individually tightened. A structure of this type is illustrated in Figs. 12, 13, and 14. This splint includes a curved arm engaging portion I25 which is similar to the arm engaging portions I and 55 of the previously described embodiments. Straps I21 are provided for attaching th arm engaging portion I25 to the arm of the patient, and a hand support I29 of the cock-up type illustrated in Figs. and 11 is supported upon the arm engaging portion I by suitable screw fastenings I3I so as to be adjustable longitudinally thereof.

The spool unit, which is the most important part of this embodiment of the invention, includes a main supporting yoke I33 for the four finger supporting spools I31. The yoke I33 is adjustably supported on the arm engaging portion I25 by means of a bracket I39, a swivel connection I4 I which may be similar to the swivel connection 8I previously described, and a longitudinally extending support member I43 which is not illustrated in detail but which may be similar to the longitudinally extending member 85 of the previously described embodiment. The support I43 is attached to the arm engaging portion I25 by the screw fastenings I3I, as illustrated, and should be provided with elongated slots similar to the slots and I03 in order to permit longitudinal adjustment of the spool unit relative to-the arm engaging portion I25.

The means which makes possible individual tensioning adjustment of the spools I31 of this unit includes a central shaft I45 which extends between the two side portions I41 of the yoke and which is keyed to the second spool I31 (from the top of Figs. 12 and 13) by a suitable keying pin I 49 which engages a slot I5I formed in the shaft I41. The slot I51 permits limited adjustment of the spool longitudinally of .the shaft. A ratchet gear I53 is keyed to the shaft I45 at the upper end thereof (Figs. 12 and 13), and a suitable spring pressed pawl I55 is provided for cooperating therewith. The ratchet gear I53 has a square, integral head portion I51 for engagement by a suitable wrench, such as that illustrated at I59 in Fig. 15, to effect rotation of the ratchet, the central shaft I45 and the spool which is keyed thereto.

A cylindrical tube I6I is positioned about the central shaft I45, as illustrated in Figs. 12 and 13, and is rotatable relative thereto. The tube IBI serves as the supporting and operating means for the uppermost spool I31, and is keyed to that spool by means of'a keying pin I63 which engages a suitable slot I55 formed in the tube I5 I. The slot I65, like the slot I5I in thecentral shaft I45, permits limited adjustment of the'upper spool longitudinally of the spoolunit, The tube I6! is provided with a ratchet gear I61 similar to the ratchet gear I53, and a second pawl I69 is provided at the upper end of the spool'unit for cooperating with this ratchet gear. The ratchet gear IE1 is also provided with a square head portion I'II for engagement by the wrench I59 or other operating member.

The two lower spools I31 are similarly supported for independent rotative movement upon the central shaft I45 by means of a pair of concentric tubes I13 and I15, each of which terminates in a ratchet gear I11 having a square head I19, and the whole assembly is held together by suitable screw fastenings I8I which engage the central shaft I45. Pawls I83 are provided for cooperating with the ratchet gears I11, and the dimensions of the central shaft I45, and the tubes I13 and I15 are such that those members are independently rotatable. The lower spools I31 are keyed to the tubes I13 and I15 by means of suitable keying pins I85 which engage slots I81 formed in the tubes, thereby permitting adjustment of the spools longitudinally of the spool unit.

It will be evident that this arrangement provides a finger tensioning splint wherein the individual finger supporting spools can be tightened independent of the others and in addition can be individually adjusted transversely of the splint (longitudinally of the spool unit). The splint is, therefore, particularly adapted for treatment of multiple fractures. It may, of course, be used for the treatment of single fractures. The use of a swivel joint between the spool unit and the arm engaging portion of the splint makes possible a completely universal type of splint which can be readily adjusted for use on' either hand.

In the foregoing, I have described the features of an improved splint particularly suited for use in the treatment of fractures of the proximal phalanges of the thumb, and fingers and of the middle phalanges of the fingers. Various embodiments of the invention have been specifically described. It will be apparent, however, that other tructural arrangements, utilizing the principles which I have disclosed in the foregoing, will be suggested to those skilled in the art. Accordingly, it is my desire that the accompanying claims shall be accorded the broadest reasonable construction consistent with the language appearing therein and the prior art.

I claim:

1. A splint of the class described comprising, a forearm engaging member curved to fit the volar surface of the forearm, a hand rest supported on 7 said forearm engaging member, and means, which includes arotatable spool and means for latching said spool in adjusted position, supported on said forearm engaging member for positioning and tensioning the digit which is being treated.

2. A splint, particularly adapted for treating fractures of the proximal and middle phalanges of the digits of the hand, comprising, a relatively rigid, forearm engaging member curved to fit the volar surface of the forearm, a hand rest, which includes a transverse support for the palm of the hand, supported on said forearm engaging por-. tion, and a digit supporting and tensioning means which includes a rotatable spool and a ratchet for holding said spool in predetermined tensioning position, saidspool and ratchet being mechanically connected to said forearm engaging portion by a rigid support means.

3. A splint, particularly adapted for treating fractures of the proximal phalange of the thumb, comprising a rigid, forearm engaging member curved to' fit the volar surface of the forearm, a hand support which includes a cross piece for engaging the hand of the patient and means for mechanically connecting said cross piece to said forearm engaging member, and a combination thumb support and thumb tensioning means which includes a rotatable spool, ratchet means for holding said spool against rotation and for permitting adjustment of the tension applied to the thumb of the patient during the use of said splint, and means for supporting said spool and ratchet means on said forearm engaging member,

the axis of rotation of said spool extending generally at right angles to said hand support member and said arm engaging member. 7

4. A splint, for use in the treatment of fractures of the proximal and middle phalanges of the fingers comprising a rigid, forearm engaging member which is curved to fit the volar surface of the forearm, a rigid, hand support afiixed to said forearm engaging member, and means for supporting and tensioning the fractured phalange which is to be treated comprising a plurality of spool members, a shaft upon which said spool members are rotatably supported, means for keying said spool members to said shaft, means for latching said shaft in a fixed rotative position, and means for supporting said shaft, said spools and said latching means on said forearm engaging member.

5. A splint, particularly adapted for treating fractures of the proximal and middle phalanges of the fingers, comprising a forearm engaging member which is curved to fit the volar surface of the forearm, a hand rest rigidly supported on said forearm engaging member, and a digital supporting and tensioning means comprising a yoke, a shaft supported on said yoke, a plurality of spool members rotatably supported on said shaft, means for selectively keying individual spools to said shaft, ratchet means whereby said shaft and any spool which is keyed thereto can be held in a fixed rotative position, and means including a connection which permits adjustment of said digital supporting and tensioning means in a lateral and a vertical plane for supporting said digital supporting and tensioning means on said forearm engaging member.

6. A splint, particularly adapted for treating fractures of the proximal and middle phalanges of the fingers, comprising a rigid, forearm engaging member which is curved to fit the volar surface of the forearm, a hand support which includes a transverse hand support member and means for rigidly supporting said member on said forearm engaging member, and a digital tensioning and support means including a yoke, a shaft supported upon said yoke, a plurality of spools supported on said shaft, means for selectively keying individual spools to said shaft, a ratchet for locking said shaft and any spool which is keyed thereto in predetermined position, and means including a swivel for adjustably supporting said digital support and tensioning means upon said forearm engaging member.

'7. A splint, particularly adapted for treating fractures of the proximal and middle phalanges of the fingers, comprising a forearm engaging member which is curved to fit the volar surface of the forearm, a hand support which is adapted to engage the hand of the patient and which is supported on said forearm engaging member, and a combination digital tensioning and support means which includes a shaft, a plurality of spool members supported upon said shaft so as to be rotatable thereon, ratchet means for individually latching each of said spool members in predetermined tensioning position during the use of said splint, and means for supporting said spool, ratchet, and shaft assembly on said forearm ening member.

8. A splint, particularly adapted for treating fractures of the proximal and middle phalanges of the fingers, comprising a rigid, forearm engaging member which is curved to fit the volar surface of the forearm, a hand support which is adapted to engage the hand of the patient and which is supported upon said forearm engaging member, and a combination digital tensioning and support means which includes a shaft, a plurality of tube members supported upon said shaft so as to be rotatable independently of said shaft and of each other, a plurality of spool members, one of which is supported upon and keyed to said shaft and to each of said tube members, ratchet means for cooperating with said shaft and said tube members for individually latching each of said keyed spool members in predetermined tensioning position during the use of said splint, and means for supporting said shaft, spool, and ratchet assembly on said forearm engaging member.

9. A splint, particularly adapted for treating fractures of the proximal and middle phalanges of the fingers, comprising a rigid, forearm engaging member which is curved to fit the volar surface of the forearm, a hand support which is adapted to engage the hand of the patient and which is supported on said forearm engaging member, and a combination, digital tensioning and supporting means which includes a shaft, a plurality of tube members supported on said shaft so as to be rotatable independently of said shaft and of each other, a plurality of spool members, one of which is supported upon and keyed to said shaft and to each of the tube members, said keying means permitting limited adjustment of each of said spools longitudinally of the associated supporting shaft or tube member, ratchet means individually associated with said shaft and each or said tube members for individually latching each of said keyed spool members in predetermined tensioning position during the use of said splint, and means including a yoke and a swivel for adjustably supporting said shaft, tube, spool, and ratchet assembly on said forearm engaging member.

MITCHELL S. CORBETT. 

